June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Comparison of Macular Ganglion Cell Complex and Retinal Nerve Fiber Layer Measurements in Glaucomatous Eyes with Peripapillary Atrophy
Author Affiliations & Notes
  • Jessica J Moon
    Ophthalmology, New England Eye Center/Tufts Medical Center, Boston, Massachusetts, United States
  • Cynthia Mattox
    Ophthalmology, New England Eye Center/Tufts Medical Center, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Jessica Moon, None; Cynthia Mattox, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 698. doi:
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      Jessica J Moon, Cynthia Mattox; Comparison of Macular Ganglion Cell Complex and Retinal Nerve Fiber Layer Measurements in Glaucomatous Eyes with Peripapillary Atrophy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):698.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Thinning of the retinal nerve fiber layer (RNFL) of the optic nerve as measured by optical coherence tomography (OCT) is a well-known parameter for detecting and measuring progression of glaucoma. However, interpreting the RNFL thickness in glaucoma can be challenging when peripapillary atrophy (PPA) is present around the nerve. Recent studies have demonstrated that the macular ganglion cell complex (GCC) is comparable to the RNFL parameters in monitoring glaucoma. To our knowledge, this is the first study to compare the glaucoma detection ability of macular GCC thickness with that of the RNFL thickness when there is confounding PPA.

Methods : We performed a retrospective chart review and analyzed 139 eyes including 28 control eyes with PPA but no glaucoma and 111 eyes with PPA and glaucoma. The latter group was further divided into 46 eyes with mild PPA and mild-moderate glaucoma, 34 eyes with mild PPA and severe glaucoma, 16 eyes with severe PPA and mild-moderate glaucoma, and 15 eyes with severe PPA and severe glaucoma. Mild PPA was defined as atrophy within the standard scan circle on OCT. Severe PPA was defined as atrophy touching or extending outside the circle. The area under the receiver operating characteristic curves (AUC) of average GCC and RNFL thickness for differentiating eyes with PPA and glaucoma from control subjects with PPA but no glaucoma were determined.

Results : When there is mild PPA and severe glaucoma, the AUC for average RNFL thickness is significantly higher than that of the average GCC thickness at 0.984 and 0.884, respectively (P<0.05). The AUCs for average GCC and RNFL thickness are comparable when there is mild PPA and mild-moderate glaucoma as well as severe PPA and severe glaucoma. However, when there is severe PPA and mild-moderate glaucoma, the AUC for GCC is higher than that of RNFL at 0.944 and 0.854, respectively.

Conclusions : In eyes with mild PPA and severe glaucoma, the traditional RNFL thickness ultimately had better glaucoma diagnostic ability. However, in eyes with severe PPA and mild-moderate glaucoma, GCC thickness was superior to RNFL in detecting glaucoma. In all other cases, GCC and RNFL were comparable. Average macular GCC thickness may be a useful method of detecting and monitoring most cases of glaucoma when the surrounding PPA makes interpreting the RNFL thickness of the optic nerve difficult.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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